• Pediatric Infection and Vaccine
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• v.5 no.1
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• pp.69-78
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• 1998

Purpose : The risk of severe tuberculous disease such as meningitis or miliary tuberculosis increases as younger is the child at the time of infection. Therefore, the early diagnosis and prompt treatment is mandatory for infants with tuberculosis. This study was undertaken to describe the epidemiology, clinical and radiographic manifestations, and response to therapy in infants with tuberculous disease. Methods : Medical records of 29 infants with tuberculosis diagnosed at the Seoul National University Children's Hospital from July, 1985, to April, 1997, were reviewed, retrospectively. A case of tuberculosis was confirmed if M. tuberculosis was isolated from any body site or if there was histologic proof of tuberculosis. Otherwise, the diagnoses were individualized considering history of contact with contagious adult case, clinical manifestations, chest X-ray findings, result of a Mantoux test reaction with 5 tuberculin unit of PPD, and the response to therapy. Results : The mean age at diagnosis was $7.00{\pm}2.65$ months (range, 3 to 12 months). Twelve cases had isolated pulmonary diseases, and the rest had pulmonary disease and meningitis, 5 cases; pulmonary disease and cervical lymphadenitis, 3; isolated meningitis, 3; and miliary tuberculosis, 6. Source case was identified in 19 cases, 7 of which were detected with retrograde manner. Twenty seven of 29 were symptomatic at their initial visit. The presenting symptoms were mainly respiratory or neurologic, and respiratory difficulty was accompanied in 7 cases. Physical examination revealed wheezing in 7 cases and decreased breath sounds in 9. Hepatomegaly or hepatosplenomegaly were frequent. Chest radiographs showed lung parenchymal disease with hilar lymphadenopathy in 18 cases, and focal or generalized emphysematous change in 7 cases. Conclusion : Most of the infants with tuberculosis are symptomatic at diagnosis, and many of infants with intrathoracic tuberculosis presented with symptoms of bronchial obstruction. When tuberculosis is suspected in an infant, the adult source case should be vigorously investigated to aid in diagnosis and for the prevention of further transmission of tuberculous disease. Almost half of infant tuberculosis are preventable if prophylaxis were given when adult cases were diagnosed.

• Radiation Oncology Journal
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• v.12 no.2
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• pp.175-184
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• 1994

From March 1983 through January 1990, two hundred sixty six patients with non-small cell lung cancer were treated with external radiation therapy at the Department of Therapeutic Radiology, Kangnam St. Mary's Hospital, Catholic University Medical College. A retrospective analysis was performed on eligible 116 patients who had been treated with radiation dose over 40 Gy and had been able to be followed up. There were 104 men and 12 women. The age ranged from 33 years to 80 years (median ; 53 years). Median follow up period was 18.8 months ranging from 2 months to 78 months. According to AJC staging system, there were 18($15.5\%$) patients in stage II, 79($68.1\%$) patients in stage III and 19($16.4\%$) patients in stage IV. The Pathologic classification showed 72($62.8\%$) squamous cell carcinomas, 16($13.8\%$) adenocarcinomas, 7($6\%$) large cell carcinomas, 5($4\%$) undifferentiated carcinomas, and 16($13.8\%$) un-known histology. In Karnofsky performance status, six ($5.2\%$) patients were in range below 50, 12($10.4\%$) patients between 50 and 60, 46($39.6\%$) patients between 60 and 70, 50($44.0\%$) patients between 70 and 80 and only one ($0.8\%$) patient was in the range over 80. Sixty ($51.7\%$) patients were treated with radiation therapy (RT) alone. Thirty three ($28.4\%$) patients were treated in combination RT and chemotherapy, twenty three ($19.8\%$) patients were treated with surgery followed by postoperative adjuvant RT and of 23 Patients above, five ($4.3\%$) patients, were treated with postoperative RT and chemotherapy. Overall response according to follow-up chest X-ray and chest CT scans was noted in $92.5\%$ at post RT 3 months. We observed that overall survival rates at 1 year were $38.9\%$ in stage II, $27.8\%$ in stage III, and $11.5\%$ in stage IV, and 2 year overall survival rates were $11.1\%$ in stage II, $20.8\%$ in stage III and $10.5\%$ in stage IV, respectively. We evaluated the performance status, radiation dose, age, type of histology, and the combination of chemotherapy and/or surgery to see the influence on the results fellowing radiation therapy as prognostic factors. Of these factors, only performance status and response after radiation therapy showed statistical significance (P<0.05)

• Tuberculosis and Respiratory Diseases
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• v.64 no.5
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• pp.356-361
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• 2008

Background: We wanted to examine the clinical characteristics of adult patients with tracheobronchial foreign bodies (FBs) according to the risk of aspiration and the outcomes of intervention with using a fiberoptic bronchoscope. Methods: From December 1994 through December 2004 at Kyung Hee Medical Center, we retrospectively analyzed the medical records of 29 adult patients with FBs that were identified by using a fiberoptic bronchoscope. Results: 14 patients were not at risk of aspiration, whereas 15 had cerebrovascular diseases and they were at a high risk of aspiration. No history suggestive of FB aspiration was noted in 7 (24.1%) patients. Respiratory symptom(s) were noted in 22 patients, and these symptoms were cough (62.0%), dyspnea (44.8%), fever (20.7%), wheezing (13.8%), chest pain (10.3%) and hemoptysis (0.4%). Only 60% of those patients at a high risk of aspiration had symptom(s) (92.8% of those patients without a risk of aspiration had symptoms, p=0.005). Those patients at risk for aspiration had a longer duration of symptoms (median: 4 days vs. 2 days for those patients not at risk for aspiration, p=0.007) before diagnosis. Acute respiratory symptom(s) within 3 days after aspiration were more frequent in the patients without a risk of aspiration (9 vs. 4, respectively p=0.048). Chest x-ray revealed radiological abnormalities in 23 patients, and these were opacities suspicious of FB (n=11), pneumonia (n=8), air trapping (n=5) and atelectasis (n=3). There were no differences in radiological findings according to the risk of aspiration. FB aspiration developed most commonly during medical procedures (57.1% for the patients at risk) and during eating (35.7% for the patients without risk). The most common FB materials were teeth (n = 11). Alligator jaw biopsy forceps (n = 23) was the most commonly used equipment. All of the FBs were removed without significant complications. Conclusion: This study underlines that a tracheobronchial FB in the patients who are at a high risk of aspiration are more likely to overlooked because of the more gradual onset of symptoms and the symptoms develop iatrogenically in many cases.

• Journal of the Korean Society of Radiology
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• v.17 no.6
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• pp.903-909
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• 2023

The purpose of this study is to compare and analyze the effect of changes in the patient's central position on the exposure dose and image quality of surrounding organs during a chest lateral examination using an Auto Exposure Control(AEC). The experiment was conducted on a human body phantom. A needle was attached to the lower part of the center of the coronal plane of the phantom, and a lead ruler was attached to the lower part of the detector so that the 50 cm point was located at the lower center of the AEC ion chamber. The exposure conditions were 125 kVp, 320 mA, the distance between the source and the image receptor was 180 cm, and the exposure field size was 14 × 17 inches. Only one AEC ion chamber was used at the bottom center, and the density was set to '0' and sensitivity to 'Middle', and the central X-ray was incident vertically toward the 6th thoracic vertebra. With AEC mode applied, the 50 cm point of the needle and lead ruler were aligned and the phantom was moved 5 cm toward the stomach (F5) and 5 cm toward the back (B5), and the dose factor was analyzed by measuring ESD. The ESD of the thyroid gland according to the change in patient center position was 232.60±2.20 μGy for Center, 231.22±1.53 μGy for F5, and 184.37±1.19 μGy for B5, and the ESD of the breast was 288.54±3.03 μGy for Center, F5 was 260.97±1.93 μGy, B5 was 229.80±1.62 μGy, and the ESD of the center of the lung was 337.02±3.25 μGy for Center, F5 was 336.09±2.29 μGy, and B5 was 261.76±1.68 μGy. As a result of comparing the average values of dose factors between each group, the difference in average values was statistically significant (p<0.01), and each group appeared to be independent. As a result of the study, there was no significant difference in the dose to the thyroid, breast, and center of the lung according to the change in the patient's central position, except for the breast (10%) when the patient moved forward about 5 cm. However, movement of about 5 cm posteriorly resulted in an average dose reduction of 23.7%. Additionally, when the patient's central position was moved to the rear, image quality deteriorated.

• Tuberculosis and Respiratory Diseases
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• v.44 no.1
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• pp.69-84
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• 1997

Background : Although the overall prognosis of patients with lung cancer is poor, highly effective treatment exists for the small subset of patients with early lung cancer(carcinoma in situ/micro- invasive cancer). But very few patients have benefit from them because these lesions are difficult to detect and localize with conventional white-light bronchoscopy. To overcome this problem, a Lung Imaging Fluorescence Endoscopic device(LIFE) was developed to detect and clearly delineate the exact location and extent of premalignant and early lung cancer lesions using differences in tissue autofluorescence. Purpose : The purpose of this study was to determine the difference of sensitivity and specificity in detecting dysplasia and carcinoma between fluorescence imaging and conventional white light bronchoscopy. Material and Methods : 35 patients (16 with abnormal chest X-ray, 2 with positive sputum study, 2 with undiagnosed pleural effusion, 15 with respiratory symptom) have been examined by LIFE imaging system. After a white light bronchoscopy, the patients were submitted to fluorescence bronchoscopy and the findings of both examinations have been classified in 3 categories(class I, II, III). From of all class n and III sites, 79 biopsy specimens have been collected for histologic examination: a comparison between histologic results and white light or fluorescence bronchoscopy has been performed for assessing sensitivity and specificity of the two methods. Results : 1) Total 79 sires in 35 patients were examined. Histology demonstrated 8 normal mucosa, 21 hyperplasia, 23 dysplasia, and 27 microinvasive and invasive carcinoma. 2) The sensitivity of white light or fluorescence bronchoscopy in detecting dysplasia was 60.9% and 82.6%, respectively. 3) The results of this study showed 70.3 % sensitivity for microinvasive or invasive carcinoma with LIFE system, versus 100% sensitivity for white light in 27 cases of carcinoma. The false negative study of LIFE system was 8 cases(3 adenocarcinoma and 5 small cell carcinoma), which were infiltrated in submucosal area and had normal epithelium. Conclusion : To improve the ability 10 diagnose and stage more accurately, fluorescence imaging may become an important adjunct to conventional bronchoscopic examination because of its high detection rate of premalignant and malignant epithelial lesion. But. it has limitation to detect in submucosal infiltrating carcinoma.

• Tuberculosis and Respiratory Diseases
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• v.43 no.5
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• pp.671-682
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• 1996

Background : Endobronchial tuberculosis is definded as tuberculous infection of the tracheobronchial tree with microbiological and histopathological evidence. Endobronchial tuberculosis has clinical significance due to its sequela of cicatrical stenosis which causes atelectasis, dyspnea and secondary pneumonia and may mimic bronchial asthma and pulmanary malignancy. Method : The authors carried out, retrospectively, a clinical study on 201 patients confirmed with endobronchial tuberculosis who visited the Department of Pulmonary Medicine at Hangyang University Hospital from January 1990 10 April 1996. The following results were obtained. Results: 1) Total 201 parients(l9.5%) were confirmed as endobronchial tuberculosis among 1031 patients who had been undergone flexible bronchofiberscopic examination. The number of male patients were 55 and that of female patients were 146. and the male to female ratio was 1 : 2.7. 2) The age distribution were as follows: there were 61(30.3%) cases in the third decade, 40 cases(19.9%) in the fourth decade, 27 cases(13.4%) in the sixth decade, 21 cases(10.4%) in the fifth decade, 19 cases(9.5%) in the age group between 15 and 19 years, 19 cases(9.5%) in the seventh decade, and 14 cases(7.0%) over 70 years, in decreasing order. 3) The most common symptom, in 192 cases, was cough 74.5%, followed by sputum 55.2%, dyspnea 28.6%, chest discomfort 19.8%, fever 17.2%, hemoptysis 11.5%, in decreasing order, and localized wheezing was heard in 15.6%. 4) In chest X-ray of 189 cases, consolidation was the most frequent finding in 67.7%, followed by collapse 43.9%. cavitary lesion 11.6%, pleural effusion 7.4%, in decreasing order, and there was no abnormal findings in 3.2%. 5) In the 76 pulmanary function tests, a normal pattern was found in 44.7%, restrictive pattern in 39.5 %, obstructive pattern in 11.8%, and combined pattern in 3.9%. 6) Among total 201 patients, bronchoscopy showed caseous pseudomembrane in 70 cases(34.8%), mucosal erythema and edema in 54 cases(26.9%), hyperplastic lesion in 52 cases(25.9%), fibrous s.enosis in 22 cases(10.9%), and erosion or ulcer in 3 cases(1.5%). 7) In total 201 cases, bronchial washing AFB stain was positive in 103 cases(51.2%), bronchial washing culture for tuberculous bacilli in 55 cases(27.4%). In the 99 bronchoscopic biopsies, AFB slain positive in 36.4%. granuloma without AFB stain positive in 13.1%, chronic inflammation only in 36.4%. and non diagnostic biopsy finding in 14.1%. Conclusions : Young female patients, whose cough resistant to genenal antitussive agents, should be evaluated for endobronchial tuberculosis, even with clear chest roentgenogram and negative sputum AFB stain. Furthermore, we would like to emphasize that the bronchoscopic approach is a substantially useful means of making a differential diagnosis of atelectasis in older patients of cancer age. At this time we have to make a standard endoscopic classification of endobronchial tuberculosis, and well designed prospective studies are required to elucidate the effect of combination therapy using antituberculous chemotherapy with steroids on bronchial stenosis in patients with endobronchial tuberculosis.

• Tuberculosis and Respiratory Diseases
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• v.44 no.2
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• pp.232-240
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• 1997

Background : Postprimary pulmonary tuberculosis is located mainly in upper lobes. The tuberculous lesion involving the lower lobes usually arises from the upper lobe cavity through endobronchial spread. When tuberculosis is confined to the lower lung field, it often masquerades as pneumonia, lung cancer, bronchiectasis, or lung abscess. Thus the correct diagnosis may be sometimes delayed for a long time. Methods : We carried out, retrospectively, a clinical study on 50 patients confirmed with lower lung field tuberculosis who visited the Department of Pulmonary Medicine at Hanyang University Hospital from January 1992 to December 1994. The following results were obtained. Results : Lower lung field tuberculosis without concomitant upper lobe disease occurred in fifty patients representing 6.9% of the total admission with active pulmonary tuberculosis over a period of 3 years. It occurred most frequently in the third decade but age distribution was relatively even. The mean age was 43 years old. Female was more frequently affected than male (male to female ratio 1 : 1.9). The most common symptom was cough(68%), followed by sputum(52%), fever(38%), and chest discomfort(30%). On chest X-ray of the 50patients, consolidation was the most common finding in 52%, followed by solitary nodule(22%) collapse(16%), cavitary lesion(10%), in decreasing order. The disease confined to the right side in 25 cases, left side 20 cases, and both sides 5 cases. Endobronchial tuberculosis (1) Endobronchial involvement was proved by bronchoscopic examination in 20 of 50patients. (2) Mean age was 44years old and female was more affected than man (male to female ratio 1 : 3). Sputum AFB stain and Mycobacterium tuberculosis culture were positive only in 50% of cases unlikely upper lobe tuberculosis, additional diagnostic methods were needed. In our study, bronchoscopic examination and percutaneous fine needle aspiration biopsy increased diagnostic yield by 18% and 32%, respectively. The most common associated condition was diabetes mellitus(18%) and others were anemia, anorexia nervosa, stomach cancer, and systemic steroid usage. Conclusion : When we find a lower lung field lesion, we should suspect tuberculosis if the patient has diabetes mellitus, anemia, systemic steroid usage, malignancy or other immune suppressed states. Because diagnostic yield of sputum AFB smear & Mycobacterium tuberculosis culture was low, additional diagnostic methods such as bronchoscopy and fine needle aspiration biopsy were needed.

• Journal of Yeungnam Medical Science
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• v.11 no.2
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• pp.240-247
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• 1994

To evaluate the isolation rate of acid-fast bacilli on Ziehl-Neelsen stain from biopsy specimens of extrapulmonary tuberculosis proven by chronic granulomatous inflammation, 286 cases of extrapulmonary tuberculosis were reviewed and the results are as follows: 1) Mean age was 27.3 years old and lymphatic tuberculosis was more prevalent in the female but others were more common in the male. 2) The most common site of extrapulmonary tuberculosis was pleura (103 cases;36%) followed by lymph nodes (87 cases;30.4%), gastrointestinal tract (27 cases;9.4%), skin and soft tissue (23 cases;8.0%), bone (19 cases; 6.6%), urinary tract (14 cases;4.6%), larynx (9 cases;3.2%) and breast (5 cases;1.8%) in order of frequencies. 3) Of 286 cases, 30.4% (87 cases) of the biopsy specimens showed acid fast bacilli on microscopy. The isolation rate according to the sites was slightly higher in breast and lymph nodes as 3 of 5 cases (60.0%) and 35 of 87 cases (40.2%) respectively, and followed by 3 of 9 cases (33.3%) in the larynx, 4 of 13 cases (30.8%) in the urinary tract, 5 of 19 cases (26.3%) in the bone, 7 of 27 cases (25.9%) in the gastrointestinal tract, 26 of 103 cases (25.2%) in the pleura, and 4 of 23 cases (17.4%) in the skin and soft tissue, in order of frequencics. 4) The prevalence of extrapulmonary tuberculosis associated with pulmonary tuberculosis on chest X-ray was 85 of 286 cases (29.7%).

• Progress in Medical Physics
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• v.23 no.1
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• pp.26-32
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• 2012

The magnification technique has recently become popular in bone radiography, mammography and other diagnostic examination. However, because of the finite size of X-ray focal spot, the magnification influences various imaging properties with resolution, noise and contrast. The purpose of study is to investigate the influence of magnification and focal spot size on digital imaging system using eDQE (effective detective quantum efficiency). Effective DQE is a metric reflecting overall system response including focal spot blur, magnification, scatter and grid response. The adult chest phantom employed in the Food and Drug Administration (FDA) was used to derive eDQE from eMTF (effective modulation transfer function), eNPS (effective noise power spectrum), scatter fraction and transmission fraction. According to results, spatial frequencies that eMTF is 10% with the magnification factor of 1.2, 1.4, 1.6, 1.8 and 2.0 are 2.76, 2.21, 1.78, 1.49 and 1.26 lp/mm respectively using small focal spot. The spatial frequencies that eMTF is 10% with the magnification factor of 1.2, 1.4, 1.6, 1.8 and 2.0 are 2.21, 1.66, 1.25, 0.93 and 0.73 lp/mm respectively using large focal spot. The eMTFs and eDQEs decreases with increasing magnification factor. Although there are no significant differences with focal spot size on eDQE (0), the eDQEs drops more sharply with large focal spot than small focal spot. The magnification imaging can enlarge the small size lesion and improve the contrast due to decrease of effective noise and scatter with air-gap effect. The enlargement of the image size can be helpful for visual detection of small image. However, focal spot blurring caused by finite size of focal spot shows more significant impact on spatial resolution than the improvement of other metrics resulted by magnification effect. Based on these results, appropriate magnification factor and focal spot size should be established to perform magnification imaging with digital radiography system.

• Pediatric Infection and Vaccine
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• v.16 no.2
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• pp.167-174
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• 2009

Purpose : Pertussis was very common in the past, but reported cases have dramatically decreased. The improvement of vaccination programs and unreadiness of laboratory confirmation seems to have developed this situation. This study investigated the frequency of pertussis among infants with a paroxysmal cough and compared the clinical characteristics between infants with and without pertussis. Methods : Between June and November 2006, 27 infants admitted to the hospital that were 15-90 days old with a history of a cough for more than seven days were enrolled. The cough was described as: paroxysmal, whooping, and post-tussive vomiting. PCR and cultures for Bordetella pertussis with nasopharyngeal aspirates were obtained. The patients were divided into two groups: (1) the pertussis group that had positive results by PCR or culture; (2) the control group that had negative results by PCR and culture. Clinical and laboratory characteristics were compared between the two groups. Results : Among the 27 cases, five (18.5%) were finally diagnosed with pertussis. Only one out of the five pertussis cases was initially diagnosed with a pertussis-like syndrome on admission. Compared to the group without pertussis, the pertussis group had a significantly higher frequency of: no fever (P =0.043), a paroxysmal cough (P =0.040), cyanosis (P =0.001), non-immunized status for DTaP (P =0.047), normal auscultation (P =0.028), normal chest X-ray findings (P =0.027), high absolute lymphocyte count (P =0.039), and low CRP (P =0.046). The patients with the diagnosis of pertussis had a significantly longer duration of coughing (27.2${\pm}$10.6 vs. 12.6${\pm}$5.6 days, P =0.039). Conclusion : Pertussis should be suspected in any infant with typical symptoms of pertussis in addition to: a persistent cough without fever, accompanied by paroxysms or cyanosis prior to the age of DTaP immunization. Active laboratory confirmation should be carried out to confirm more cases with pertussis.